Management of the Biceps Tendon

The long head of the biceps tendon (LHBT) is a common source of pathology in overhead athletes. The biceps-labrum complex is the combined anatomy of the LHBT and superior labrum, and it is imperative to understand this complex anatomical relationship for both diagnosis and management of these conditions. The etiology of LHBT pathology can be classified into the following 3 categories: inflammation, instability, and trauma. Although there are many physical examination tests for biceps tendon and superior labrum anterior to posterior lesions, many of these lack reproducible sensitivity or specificity to be clinically useful. Owing to the difficulty in diagnosing LHBT disorders, treatment should be guided by a combination of history and clinical examination findings as well as advanced imaging studies, including magnetic resonance imaging and ultrasound. Initial nonoperative treatment of LHBT pathology includes guided physical therapy, nonsteroidal anti-inflammatory medications, and corticosteroid injections. When nonoperative management fails, surgical treatment includes the following 3 common procedures: superior labrum anterior to posterior repair, biceps tenotomy, and biceps tenodesis. When treated appropriately, overhead athletes with LHBT pathology often experience excellent clinical outcomes.